Who should treat liver transplant patients? The transplant hepatologist or the gastroenterologist? Part I: the transplant hepatologist.

摘要

Over the last several decades, treatment options for patients with end stage liver disease have increased dramatically. For example, liver transplantation, once considered an experimental procedure performed in critically ill patients otherwise not expected to survive, has now emerged as the treatment of choice for appropriately selected patients with end stage liver disease who do not respond to alternative medical or surgical therapies. Improved post-transplantation outcomes have been achieved due to advances in surgical technique and immunosuppression, selection of appropriate donors, organs, and recipients, and improved therapies to prevent and treat post-operative complications . Ironically, improvement in post-transplantation survival has led to the emergence of complications associated with patient longevity, including non-hepatic disease, side effects of immunosuppression, infection, neoplasia, and recurrence of the primary disease for which the liver transplantation was indicated [2-11]. Thus,as 'victims of our own success', modern liver transplantation provides a unique opportunity to save patients who would otherwise succumb to their liver disease, at the expense of inducing a new set of complications which need to be managed long-term.